CMS Price Transparency Data

Colonoscopy with biopsy

Facility: Memorial Hospital

Billing Code: 45380 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 45380
Insurance Median: $1,809
Cash Discount Price: $3,115
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Colonoscopy with biopsy at Memorial Hospital is $1,809. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,115. Compared to the federal Medicare reimbursement reference rate of $1,222.56, this hospital’s rate is 1.48x the Medicare baseline. Located in 4500 Memorial Drive, Belleville, IL.

Cash / Self-Pay

$3,115

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,809

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$1,222.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $1,222.56 (100%)

Cash / Self-Pay: $3,115 (255%)

Insurance Median: $1,809 (148%)

Cash: $3,115 (255% of Medicare)

Ins. Median: $1,809 (148% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $1,222.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Healthscope Benefits [258]	$531 - $1,925	43%
UnitedHealthcare	$531 - $1,925	43%
Cox Health Systems Insurance Company [220]	$648 - $1,297	53%
Health Alliance [224]	$648 - $1,297	53%
Allied Benefits [498]	$684 - $2,281	56%
Hope Trust [806]	$684 - $1,368	56%
Healthcare Sol Mercy [609]	$884 - $1,768	72%
Med-Pay [480]	$884 - $1,768	72%
Medica [661]	$943 - $1,886	77%
Phcs [244]	$943 - $1,886	77%
Blue Cross Blue Shield	$1,026 - $2,051	84%
Aetna	$1,199 - $2,281	98%
Essence Healthcare [221]	$1,199	98%
Humana	$1,199 - $6,690	98%
Cox Health [757]	$1,258	103%
Devoted Health Plan [847]	$1,258	103%
Medica [662]	$1,258	103%
Cigna	$1,693 - $6,771	138%
Consociate [478]	$1,850 - $4,587	151%
Sarah Bush Lincoln [636]	$1,850 - $4,587	151%
Coresource [497]	$2,281	187%
Fmh Benefit Service Inc [222]	$2,281	187%
Mail Handlers [495]	$2,281	187%
Apwu Health Plan [216]	$2,769 - $6,771	226%
Nalc Health Benefit Plan [242]	$2,769 - $6,771	226%
Priority Health [648]	$2,769 - $6,771	226%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $3,115.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 45380.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 45380.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.